Outpatient Intravenous Diuretic Therapy for Acute Heart Failure: A Simplified Solution to a Formidable Problem

Al‐Ani, Mohammad; Schwartz, Cody; Winchester, David E.; Barry, Julia; Cerda, Martin; Aranda, Juan M.; Ahmed, Mustafa M.

doi:10.1016/j.cardfail.2019.08.008

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…This is because 91.5% of all patients with ADHF presenting to ED get admitted, which may be partly due to established practice patterns, lack of alternative options, or presence of institutional management algorithms. Indeed, even though alternative outpatient IV diuretic based decongestion strategies for volume overloaded HF patients in clinic setting have shown to have promise, [13] , [14] , [15] , [16] , [17] there are no studies providing an alternative decongestion strategy of ADHF patients in the ED. ACC/AHA guidelines [12] , [19] do not address risk stratification, nor location of therapy, and mostly recommend that hospital management be focused on IV diuretic decongestion, continuation of home medical therapy, and discharge planning.…”

Section: Discussionmentioning

confidence: 99%

“…The guidelines instead focus on guiding therapy in the typical location of ADHF - the hospital – with the mainstay being intravenous (IV) diuresis and discharge planning. To date, there are several studies that have evaluated the efficacy and safety of outpatient IV diuresis for congested HF patients [13] , [14] , [15] , [16] , [17] who were identified in the outpatient clinics. They showed that IV furosemide administration was effective in diuresing outpatients and that it was safe, even at 200 mg bolus doses.…”

Section: Introductionmentioning

confidence: 99%

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Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure

Halatchev

Heidenreich

et al. 2021

IJC Heart & Vasculature

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Background We established an IV outpatient diuresis (IVOiD) clinic and conducted a quality improvement project to evaluate safety, effectiveness and costs associated with outpatient versus inpatient diuresis for patients presenting with acute decompensated heart failure (ADHF) to the emergency department (ED). Methods Patients who were clinically diagnosed with ADHF in the ED, but did not have high-risk features, were either diuresed in the hospital or in the outpatient IVOiD clinic. The dose of IV diuretic was based on their home maintenance diuretic dose. The outcomes measured were the effects of diuresis (urine output, weight, hemodynamic and laboratory abnormalities), 30–90 day readmissions, 30–90 day death and costs. Results In total, 36 patients (22 inpatients and 14 outpatients) were studied. There were no significant differences in the baseline demographics between groups. The average inpatient stay was six days and the average IVOiD clinic days were 1.2. There was no significant difference in diuresis per day of treatment (1159 vs. 944 ml, p = 0.46). There was no significant difference in adverse outcomes, 30–90 day readmissions or 30–90 day deaths. There was a significantly lower cost in the IVOiD group compared to the inpatient group ($839.4 vs. $9895.7, p=<0.001). Conclusions Outpatient IVOiD clinic diuresis may be a viable alternative to accepted clinical practice of inpatient diuresis for ADHF. Further studies are needed to validate this in a larger cohort and in different sites.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure

Halatchev

Heidenreich

et al. 2021

IJC Heart & Vasculature

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“…24 Two studies used a specific dosage of the bolus therapy for all patients. 25 All studies with intravenous diuretics in the outpatient setting mentioned the number of visits made to the outpatient clinic. Between 14-45% of patients had multiple outpatient clinic visits.…”

Section: Study Protocols and Treatment Regimensmentioning

confidence: 99%

“…26 Re-hospitalization rates for HF at 30 and 180 days amounted 28 and 46% respectively. All-cause re-hospitalization rates at 30 and 60 days amounted 18-37 [23][24][25] and 22%, 24 respectively. The highest HF re-hospitalization was demonstrated by Gilotra et al 28 and amounted to 52% in 30 days in the subcutaneous diuretic group and 42% in 30 days in the intravenous diuretic group.…”

Section: Endpoints and Clinical Study Outcomesmentioning

confidence: 99%

“…One study showed that 91% patients prefer the outpatient treatment above treatment at the emergency department and 89% of patients showed a Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: a systematic review of the literature 100% satisfaction visual score. 25 In the United States, approximately 19% of hospitals have the possibility of outpatient treatment with intravenous or subcutaneous diuretics, and these treatments comprise 1.4% of all outpatient visits for HF.. 31 Outpatient treatment of patients with worsening HF could avoid delays when presenting to the emergency department and streamline standard disciplinary HF care and early follow-up after treatment. 32 Furthermore, complications of hospitalization could be prevented, such as venous thrombosis, phlebitis, hospital-acquired pneumonia, ulcers due to lack of mobility, loss of control, and depression, estimated to be as high as 25%.…”

Section: Safety and Efficacy Of Outpatient Treatment Of Worsening Hfmentioning

confidence: 99%

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Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: a systematic review of the literature

Wierda¹,

Dickhoff²,

Handoko³

et al. 2020

ESC Heart Failure

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Aims In the coming decade, heart failure (HF) represents a major global healthcare challenge due to an ageing population and rising prevalence combined with scarcity of medical resources and increasing healthcare costs. A transitional care strategy within the period of clinical worsening of HF before hospitalization may offer a solution to prevent hospitalization. The outpatient treatment of worsening HF with intravenous or subcutaneous diuretics as an alternative strategy for hospitalization has been described in the literature. Methods and resultsIn this systematic review, the available evidence for the efficacy and safety of outpatient treatment with intravenous or subcutaneous diuretics of patients with worsening HF is analysed. A search was performed in the electronic databases MEDLINE and EMBASE. Of the 11 included studies 10 were single-centre, using non-randomized, observational registries of treatment with intravenous or subcutaneous diuretics for patients with worsening HF with highly variable selection criteria, baseline characteristics, and treatment design. One study was a randomized study comparing subcutaneous furosemide with intravenous furosemide. In a total of 984 unique individual patients treated in the reviewed studies, only a few adverse events were reported. Re-hospitalization rates for HF at 30 and 180 days were 28 and 46%, respectively. All-cause re-hospitalization rates at 30 and 60 days were 18-37 and 22%, respectively. The highest HF re-hospitalization was 52% in 30 days in the subcutaneous diuretic group and 42% in 30 days in the intravenous diuretic group. Conclusions The reviewed studies present practice-based results of treatment of patients with worsening HF with intravenous or subcutaneous diuretics in an outpatient HF care unit and report that it is effective by relieving symptoms with a low risk of adverse events. The studies do not provide satisfactory evidence for reduction in rates of re-hospitalization or improvement in mortality or quality of life. The conclusions drawn from these studies are limited by the quality of the individual studies. Prospective randomized studies are needed to determine the safety and effectiveness of outpatient intravenous or subcutaneous diuretic treatment for patient with worsening HF.

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The Journey Toward Advances in Diuretics Management: Quite Far and Not Far Enough

Konstam

2020

Journal of Cardiac Failure

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Outpatient Intravenous Diuretic Therapy for Acute Heart Failure: A Simplified Solution to a Formidable Problem

Cited by 9 publications

References 6 publications

Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure

Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure

Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: a systematic review of the literature

The Journey Toward Advances in Diuretics Management: Quite Far and Not Far Enough

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